Evaluation of an electronic prescription platform: Clinicians' feedback on three distinct services aiming to facilitate clinical decision and safer e-prescription

BACKGROUND

Health Care Professionals (HCPs) are the main end-users of digital clinical tools such as electronic prescription systems. For this reason, it is of high importance to include HCPs throughout the design, development and evaluation of a newly introduced system to ensure its usefulness, as well as confirm that it tends to their needs and can be integrated in their everyday clinical practice.

METHODS

In the context of the PrescIT project, an electronic prescription platform with three services was developed (i.e., Prescription Check, Prescription Suggestion, Therapeutic Prescription Monitoring). To allow an iterative process of discovery through user feedback, design and implementation, a two-phase evaluation was carried out, with the participation of HCPs from three hospitals in Northern Greece. The two-phase evaluation included presentations of the platform, followed by think-aloud sessions, individual platform testing and the collection of qualitative as well as quantitative feedback, through standard questionnaires (e.g., SUS, PSSUQ).

RESULTS

Twenty one HCPs (8 in the first, 18 in the second phase, and five present in both) participated in the two-phase evaluation. HCPs comprised clinicians varying in their specialty and one pharmacist. Clinicians' feedback during the first evaluation phase already deemed usability as "excellent" (with SUS scores ranging from 75 to 95/100, showing a mean value of 86.6 and SD of 9.2) but also provided additional user requirements, which further shaped and improved the services. In the second evaluation phase, clinicians explored the system's usability, and identified the services' strengths and weaknesses. Clinicians perceived the platform as useful, as it provides information on potential adverse drug reactions, drug-to-drug interactions and suggests medications that are compatible with patients' comorbidities and current medication.

CONCLUSIONS

The developed PrescIT platform aims to increase overall safety and effectiveness of healthcare services. Therefore, including clinicians in a two-phase evaluation confirmed that the introduced system is useful, tends to the users' needs, does not create fatigue and can be integrated in their everyday clinical practice to support clinical decision and e-prescribing.

Electronic alert outpatient protocol improves the quality of care for the risk of postcontrast acute kidney injury following computed tomography

BACKGROUND

Prevention and diagnosis of postcontrast acute kidney injury (AKI) after contrast-enhanced computed tomography is burdensome in outpatient department. We investigated whether an electronic alert system could improve prevention and diagnosis of postcontrast AKI.

METHODS

In March 2018, we launched an electronic alert system that automatically identifies patients with a baseline estimated glomerular filtration rate of <45 mL/min/1.73 m2, provides a prescription of fluid regimen, and recommends a follow-up for serum creatinine measurement. Participants prescribed contrast-enhanced computed tomography at outpatient department before and after the launch of the system were categorized as historical and alert group, respectively. Propensity for the surveillance of postcontrast AKI was compared using logistic regression. Risks of AKI, admission, mortality, and renal replacement therapy were analyzed.

RESULTS

The historical and alert groups included 289 and 309 participants, respectively. The alert group was more likely to be men and take diuretics. The most frequent volume of prophylactic fluid in historical and alert group was 1,000 and 750 mL, respectively. Follow-up for AKI was more common in the alert group (adjusted odds ratio, 6.00; p < 0.001). Among them, incidence of postcontrast AKI was not statistically different. The two groups did not differ in risks of admission, mortality, or renal replacement therapy.

CONCLUSION

The electronic alert system could assist in the detection of high-risk patients, prevention with reduced fluid volume, and proper diagnosis of postcontrast AKI, while limiting the prescribing clinicians' burden. Whether the system can improve long-term outcomes remains unclear.

Assessment of the operation status of electronic prescription at community pharmacies in Chengdu, China: a simulated patient study

BACKGROUND

Information and technologies relevant to eHealth have developed rapidly over the past two decades. Based on this, China piloted "Internet + " pattern and some regions piloted electronic prescription services to explore telepharmacy services.

OBJECTIVE

To describe the processes and assess the operation status of electronic prescription services mode for community pharmacies in China.

METHODS

The simulated patient methodology was used to conduct a cross-sectional study in 317 community pharmacies from six districts in Chengdu, China in 2019. Simulated patients expressed three levels of service demands based on scenario about acute upper respiratory tract infections to evaluate the recommendation strength of electronic prescription services and telepharmacy service in community pharmacies. The descriptive statistics was completed to obtain the characteristics of the visit process, student t-test and χ2 test (P < 0.05 was considered statistically significant) were used for inferential statistical analysis to determine differences in characteristics and degree of recommendation between pharmacies.

RESULTS

Three Hundred Seventeen record sheets were effectively collected. The third-party platform was recommended in 195 (61.5%) interactions. The main reason for not recommending is non-prescription dispensing of prescription drugs (27.1%). 90.3% interactions waited less than 1 min, the counseling duration was less than 5 min in all interactions, and most community pharmacies had good network conditions (81.5%). 97.4% remote physicians offered professional counseling, only 22.1% of the pharmacists provided medication advice.

CONCLUSIONS

The electronic prescription services mode for community pharmacies in Chengdu provides a convenient drug purchase process but remains some problems. For example, prescribing drugs without a prescription and services provided by pharmacists was poor, etc. The relevant supporting policies should be improved in future development process.

Electronic prescription system requirements: a scoping review

Background

An electronic prescription system is a mechanism that has long been implemented in many countries around the world. In the present study, we reviewed the requirements, standards, and features of an electronic prescription system for its correct and accurate execution.

Methods

This scoping review was conducted according to the PRISMA-SCR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive literature search was performed with the related keywords in Web of Science, PubMed, Scopus, and ProQuest with no time limit. The selection of papers was based on inclusion criteria. After removing duplicates, reviewing titles, abstracts, and full-text, 13 articles were included in the analysis.

Results

Electronic prescription system requirements extracted from the studies: Patient data, Patient selection or identification and data access, Drug Selection, Security, Privacy and administration, Transparency and accountability, Interoperability and communication, Monitoring, report, reminder, and renewals, Feedback at the prescriber level, Infrastructure: Computer equipment, Awareness of physicians and System support, Patient education and information, Usability, Standards, History of Medications / Current Medications, Data transfer and storage, Alerts and other messages to prescribers, and filtering of user-selectable alerts for possible prescription problems and Decision support.

Conclusions

The results of this study showed that the electronic prescription systems have several functional and technical capabilities that can provide significant benefits to all system’s stakeholders, including service providers, drug distributors, patients, and insurance organizations if used correctly.

Safer prescription of drugs: impact of the PREFASEG system to aid clinical decision-making in primary care in Catalonia

BACKGROUND

In 2008, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a prescription decision support system in its electronic clinical workstation (ECW), which automatically generates online alerts for general practitioners when a possible medication-related problem (MRP) is detected. This tool is known as PREFASEG, and at the time of beginning a new treatment, it automatically assesses the suitability of the treatment for the individual patient. This analysis is based on ongoing treatments, demographic characteristics, existing pathologies, and patient biochemical variables. As a result of the assessment, therapeutic recommendations are provided. The objective of this study is to present the PREFASEG tool, analyse the main alerts that it generates, and determine the degree of alert acceptance.

METHODS

A cross-sectional descriptive study was carried out to analyse the generation of MRP-related alerts detected by PREFASEG during 2016, 2017, and 2018 in primary care (PC) in Catalonia. The number of MRP alerts generated, the drugs involved, and the acceptance/rejection of the alerts were analysed. An alert was considered "accepted" when the medication that generated the alert was not prescribed, thereby following the recommendation given by the tool. The MRP alerts studied were therapeutic duplications, safety alerts issued by the Spanish Medicines Agency, and drugs not recommended for use in geriatrics. The prescriptions issued by 6411 ICS PC physicians who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed.

RESULTS

During the 3 years examined, 67.2 million new prescriptions were analysed, for which PREFASEG generated 4,379,866 alerts (1 for every 15 new treatments). A total of 1,222,159 alerts (28%) were accepted. Pharmacological interactions and therapeutic duplications were the most detected alerts, representing 40 and 30% of the total alerts, respectively. The main pharmacological groups involved in the safety alerts were nonsteroidal anti-inflammatory drugs and renin-angiotensin system inhibitors.

CONCLUSIONS

During the period analysed, 28% of the prescriptions wherein a toxicity-related PREFASEG alert was generated led to treatment modification, thereby helping to prevent the generation of potential safety MRPs. However, the tool should be further improved to increase alert acceptance and thereby improve patient safety.

Electronic prescription as a driver for digitalization in Finnish pharmacies

Background

Finnish community pharmacies have undergone digitalization during the past decade. The introduction of the electronic prescription has had a significant impact on pharmacy workflows, such as the dispensing process. This inevitably has significant sociotechnical implications. We examine the impact of digitalization on the dispensing process and the sociotechnical orientation of a pharmacy.

Methods

We utilize data collected in customer service situations in Finnish community pharmacies at two points in time: in the traditional workflow, when electronic prescriptions were not in use, and in the new direct dispensing workflow, which is the usual delivery model in the case of electronic prescriptions. We analyze this data in terms of changes in workflow efficiency. We also draw on existing literature to build a conceptual model for digitalization in the pharmacy sector from a sociotechnical standpoint.

Results

In the Finnish environment, the results, based on our study sample, show that with electronic prescriptions and the direct dispensing model, the delivery time for a single medication over the counter was reduced by 13%. The results also indicate that the process has become more predictable, as the variation in terms of the workflow lead time has decreased.

Conclusions

The results indicate that the dispensing process has become more efficient in terms of time and throughput as well as more technically oriented and predictable. From a sociotechnical perspective, the results indicate that the technical subsystem has strengthened, and pharmacies have adapted to the new technology in the dispensing process.

Evaluating physicians' perspectives on the efficiency and effectiveness of the electronic prescribing system

BACKGROUND

The implementation of the electronic prescribing system follows certain objectives, and users' perspectives can contribute to understanding the efficiency and effectiveness of this system. This study aimed to evaluate physicians' perspectives on the efficiency and effectiveness of the electronic prescribing system.

METHODS

This study was conducted on all physicians using the electronic prescribing system in clinics and hospitals affiliated with the treatment deputy of the Social Security Organization (SSO) in Sistan and Baluchistan Province in Iran. Data were collected using a self-administered questionnaire containing three sections: (i) Six items related to demographic data and clinical experience, (ii) Specific questions based on a five-point Likert scale-related physicians' perspectives about efficiency (19 questions) and effectiveness (13 questions), and (iii) Open-ended questions about the positive and negative aspects of using the electronic prescribing system.

RESULTS

The mean and standard deviation of the efficiency and effectiveness of the electronic prescribing system were 3.68 ± 0.67 and 3.84 ± 0.65, respectively. Patient safety had the highest mean score among all dimensions (4.0 ± 0.64). Most participants (n = 55, 79%) considered the efficiency and effectiveness of this system high. More than 90 percent of the physicians (n = 63) believed that the electronic prescribing system enables a better medication prescription by providing alerts and access to patients' medication history.

CONCLUSION

The findings showed that most physicians believed that the electronic prescribing system of Iran's SSO has high efficiency and effectiveness. In particular, physicians believed that using this system improves patient safety and reduces costs.

The state of national electronic prescription systems in the EU in 2018 with special consideration given to interoperability issues

INTRODUCTION

The electronic prescribing system (EPS) is now widely used in the USA and largely also in EU member countries. Nevertheless, comparisons of different EPS are very scarce. Whilst the EU strives for cross-border interoperability in healthcare, the aim of this study is to provide a contemporary account of the state of national EPS in such countries.

METHODS

For the sake of consistency the state of each of the EPS as of the end of 2018 was researched using an e-mail questionnaire. Respondents were chosen from among authors who have previously published studies on electronic prescriptions.

RESULTS

Data on EPS was gathered from 23 out of the 28 EU member states. In 2018 EPS was in daily use in 19 EU states, and one further country had a pilot project, whereas the remaining 3 were only at the planning stage. Most of the EPS do not differ significantly in basic design, however authentication procedures vary substantially.

DISCUSSION

There is a significant increase in EPS usage in EU countries as compared with previous studies. Cross-border interoperability in the EU is still limited, and further advancement might be hampered by differences in authentication procedures.

CONCLUSION

Although it was not possible to acquire data from all the EU countries, this study shows the present state of electronic prescription in most of them and demonstrates continuous development in this area.

[Electronic prescription: limitations and possible improvements to ensure greater adherence to treatments]

OBJECTIVE

The electronic prescription has meant an evolution in the quality of health care, but it has a series of deficiencies that compromise the adherence to treatments. The objective of this work was to collect and group these limitations and propose the changes that could solve them.

METHODS

During 2017 and 2018, through dispensing and pharmacotherapeutic monitoring activities, incidents related to the electronic prescription were collected in a pharmacy in Santander and their causes were identified. A survey was conducted and sent to the Information Centers of the Medicines of the rest of the regions to know if the same problems were shared and the resulting data were treated by frequency distribution.

RESULTS

We detected 1,500 incidents related to the way of access to the treatment and its activation period, with the availability of the medication when the patient requested it and those in which the assessment of the problem by the doctor was essential. The survey data showed that in 100% of the CCAA the patient must return to the doctor when there is an incidence, because there is no protocol to solve it from the pharmacy.

CONCLUSIONS

These incidents compromise the adherence to treatments and the health of patients. To avoid them, we propose the elimination of the password that is necessary to access the treatment, the establishment of a minimum period of 30 days for its activation, the creation of protocols so that the pharmacist can solve problems and perform dispensations in special circumstances, and finally, the optimization of the communication between pharmacist and doctor.

The past and current state of the Czech outpatient electronic prescription (eRecept)

INTRODUCTION

Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well.

METHODS

Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léčiv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained.

RESULTS

The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all.

DISCUSSION

A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits.

CONCLUSION

The Czech Republic has joined the EU countries widely using the OEPS.

Pharmacy customers' experiences with the national online service for viewing electronic prescriptions in Finland

OBJECTIVES

To investigate (1) Finnish pharmacy customers' familiarity with My Kanta, the national online service for viewing electronic prescriptions (ePrescriptions), (2) how commonly My Kanta is used, (3) who the typical users are, and (4) users' experiences of the usability of My Kanta.

METHOD

A survey was conducted among pharmacy customers (aged ≥18) purchasing medicines for themselves. Questionnaires (N=2915) were distributed from 18 community pharmacies across Finland in autumn 2015. The data obtained was stored in SPSS for Windows and subjected to descriptive analysis, chi-square tests and logistic regression analysis.

RESULTS

In total, 1288 respondents were included (response rate 44%). Most (62%) of the customers were familiar with My Kanta. The majority of them (78%) were using it to view their ePrescriptions. My Kanta was perceived as clear, easy to use and to provide a good overall picture of the prescribed medications. Familiarity with My Kanta was associated with a higher education than basic school, regular use of prescription medicines, and sufficient information received about ePrescriptions. Men used My Kanta more often than women. Respondents aged 75 or older were less likely to be familiar with and to use the service compared to 18-34year olds.

CONCLUSIONS

Most of the Finnish pharmacy customers were familiar with the national online service, My Kanta, for viewing ePrescriptions. Service users perceived it as easy to use and beneficial in managing their overall medication. Customers under 75, those educated beyond basic school, those using prescription medicines regularly, and those who had obtained sufficient information about ePrescriptions were most likely to be familiar with My Kanta. Men and customers under 75 were the typical users of the service. Some customers, however, were unaware of the service, or unable or reluctant to use it.

An evaluation of e-prescribing at a national level

OBJECTIVE

The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled.

MATERIALS AND METHODS

The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies.

RESULTS

According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains.

CONCLUSION

The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.

Assessment of legibility and completeness of handwritten and electronic prescriptions

Objectives

To assess the legibility and completeness of handwritten prescriptions and compare with electronic prescription system for medication errors.

Design

Prospective study.

Setting

King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.

Subjects and methods

Handwritten prescriptions were received from clinical units of Medicine Outpatient Department (MOPD), Primary Care Clinic (PCC) and Surgery Outpatient Department (SOPD) whereas electronic prescriptions were collected from the pediatric ward. The handwritten prescription was assessed for completeness by the checklist designed according to the hospital prescription and evaluated for legibility by two pharmacists. The comparison between handwritten and electronic prescription errors was evaluated based on the validated checklist adopted from previous studies.

Main outcome measures

Legibility and completeness of prescriptions.

Results

398 prescriptions (199 handwritten and 199 e-prescriptions) were assessed. About 71 (35.7%) of handwritten and 5 (2.5%) of electronic prescription errors were identified. A significant statistical difference (P < 0.001) was observed between handwritten and e-prescriptions in omitted dose and omitted route of administration category of error distribution. The rate of completeness in patient identification in handwritten prescriptions was 80.97% in MOPD, 76.36% in PCC and 85.93% in SOPD clinic units. Assessment of medication prescription completeness was 91.48% in MOPD, 88.48% in PCC, and 89.28% in SOPD.

Conclusions

This study revealed a high incidence of prescribing errors in handwritten prescriptions. The use of e-prescription system showed a significant decline in the incidence of errors. The legibility of handwritten prescriptions was relatively good whereas the level of completeness was very low.

Assessment of informatization for the dispensing of medications at a university hospital

INTRODUCTION

Informatics and automation are important tools for the reduction of work, errors and costs in a hospital pharmacy.

OBJECTIVES

To describe the structuring and function of an informatized system for the dispensing of medications and to assess its effect on nursing and pharmacy services during the period from 1997 to 2003.

MATERIALS AND METHODS

In this descriptive and retrospective study, we performed an analysis of documents addressing the structuring and implementation of the informatized medication dispensing system. In addition, we analyzed the perceptions of nurses, pharmacists and pharmacy assistants who participated in the structuring phase of the system when interviewed about the effect of informatization on administrative aspects (e.g., requisition of medications, presentation of the dispensed medication and system operationalization).

RESULTS

The major advantages provided by the new system were 1) the elimination of manual transcripts for prescribed medications, 2) increased speed, 3) better identification of the doses prescribed by physicians, 4) medication labels containing all necessary identification and 5) practicality and safety of optical bar code-based verification of the requested and dispensed medications.

CONCLUSIONS

The great majority of the interviewees considered the informatized medication supply system to be of good quality. Analysis of the data provided information that could contribute to the expansion and refinement of the system, provide support for studies regarding the utilization of medications and offer new perspectives for work and productivity.